Month: July 2016

As I mentioned earlier this week, I’ve been reflecting on my own diabetes quite a lot of late. Now that the dust is starting to settle on my transition to an insulin pump, I feel like there are no more corners for me to turn if I cannot make this work for me. When I made the decision to get the insulin pump earlier this year, part of my brain convinced myself that this would be the answer to getting diabetes down pat. Now that the dust has settled, I feel like I have no more excuses not to be managing my diabetes to the best of my ability.

Don’t get me wrong, I am making some promising inroads with the pump. Yet I often find myself wondering what a future with diabetes holds in store for me.

I wonder if there will ever be a cure for diabetes. Technology is amazing. I hear of incredible research breakthroughs every week. I’ve seen pictures of an artificial pancreas that could be on the market well before the end of this decade recently. I shared some incredible T1D research involving skin cells only days ago on my Facebook page here. I watch the Open Artificial Pancreas System (APS) movement driven by individuals who have hacked their insulin pumps and Continuous Glucose Monitors to communicate with each other. Yet I wonder if that cure, or that breakthrough, or that technology, will ever make its way to the average joe like me.

At work, we always joke about winning the lotto. We often play together when it jackpots, and every time it does we talk about buying suitcases and booking a trip to Las Vegas straight away. So many people my age seem to prioritise holidays, travel and leisure. Sure, I love a holiday as much as the person next to me. But I guess I’m the kind of person who leans more towards having a sense of security in life before I’m ready to jump on board a plane. Diabetes will do that to you…

I fantasise about the doctor, the dietician, the diabetes educator, chef and personal trainer that I would hire specifically for me if I won the lotto. I fantasise about paying the exorbitant costs of getting the uber cool touch screen t-slim insulin pump to Australia just for me. I fantasise about the smartphone-integrated insulin pump or glucose meter that I would pay to have manufactured specifically for me.

As I watched Andy open a Christmas in July themed OzDOC chat on Tuesday with our “grown up” diabetes Christmas wish, I didn’t have to think about my answer at all. I wonder if I will ever feel a complete sense of having this condition under control.

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I was pretty slack around actually giving my insulin doses when I was on injections. I would often find myself giving insulin after I had eaten dinner, simply because I couldn’t be bothered getting up from the table to grab my pen and work out my insulin dose. Then there was the issue of having to dose again if I’d eaten more than I’d anticipated at dinner, so I opted to be lazy and bolus once after I had eaten my dinner.

This is one of the reasons why I absolutely love having the insulin pump attached to me all the time. There really is no excuse not to be giving my insulin when I eat. Although this is not the reason I switched to an insulin pump, it does offer me a level of convenience that I simply did not have on injections.

Before the pump, my daily insulin dosing was full of lousy guesstimates, which often left me going too low or too high after meals. Last month, I wrote about how the pump had given me an added focus on my carbohydrate counting, and I’m happy to report that I am still counting my carbs diligently today.

In the past couple of weeks, I’ve slipped into a really good morning routine that sees me pre-bolussing my breakfast insulin dose 15-30 minutes before I eat every day. Breakfast is probably the easiest meal to do this for, because my morning routine is almost identical each day. I usually deliver my insulin, sit and drink my coffee, go and get dressed and then come back and have my breakfast – usually a warm bowl of Oats or a slice of toast slathered with butter. Delaying the carbs until my insulin starts working usually helps to prevent my blood sugar from spiking too high after eating. I’ve been pleased with the results so far, and I’m hoping to make this a little more routine throughout the rest of the day.

Pre-bolussing also makes the prospect of higher GI foods such as whiter breads and pastries less daunting. They used to cause a lot of frustration in the aftermath, but nowadays I find that I am not so reluctant to treat myself if I wish to.

Another thing that makes me really happy these days is that I am actually using far less insulin compared to injections. This was really hard to believe when Gwen first told me on pump day, but it is so true. My insulin to carb ratio is much wider than the one I used on injections. My basal insulin provides precise coverage to match the time of the day, and my level of activity. With diligent carbohydrate counting, my insulin dosing is far more accurate. When I think about it, I am actually having far less highs and lows after meals as a direct result of my insulin dosing.

When I compare all of this to my life prior to the pump, I am working my butt off with my diabetes at the moment. I’m super proud that I am still so focussed after two and a half months on the pump, even through burnouts. I feel that I am well on track to seeing an improvement in my hba1c result at the end of the year.

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I sit down in the evening, and I marvel at how quickly yet another day has gone by. I glance at the calendar, and I cannot believe that it will be August in a few days. I watch the mornings slowly beginning to get lighter, and I want to make the most of this beautiful time of the year before its gone once again. Another Friday rolls around, and I cannot believe how quickly the weeks are flying by.

In the grand scheme of things, there are a million things that I want to do.

I want to sit down and write, every day. I want to put more effort into my meals, rather than the usual toasted sandwich I have for lunch every day. I want to save the money I spend on the odd treat at lunchtime. I want to work on my fitness. I want to improve my hba1c. I want to finish all the odd jobs at the house this weekend. I want to read. I want to get hooked on a new TV show, instead of falling asleep out of lack of interest. I want to make time for myself. I still dream of one day having a career that I’m really passionate about. I want to feel full of energy. I want to be excited. I want to be enthusiastic. I want to go to bed feeling fulfilled at the end of the day.

In this grand scheme of this thing that we call life, there are simply not enough hours in the day to get all of these things done.

Last week at the Telethon Type 1 Diabetes Centre in Perth, Canadian T1D athlete Sebastien Sasseville spoke about having a bank of good and bad blood sugar levels. He reminded us that there’s no point focussing on those bad readings that were deposited in the past. Like anything in the past, there’s nothing I can do to change it. I can only look forward, and at what I can do today to deposit more readings into the good blood sugar bank.

I’ve definitely been reflecting on my own diabetes management quite a lot at the moment, particularly now that things are starting to settle somewhat with my insulin pump. I think a lot about where I’m hoping to be with my diabetes in the long run, and what I hope to achieve.

One of my favourite quotes reads “no expectations, no disappointment.” I’m often reminded of the diabetes goal I set for myself at the beginning of the year. That goal of striving for stable overnight glucose levels was full of expectations, and led to a lot of disappointment.

While I’m unlikely to start training for a climb up Mount Everest or a triathlon across Canada anytime soon, I did take away a small piece of inspiration from Seb’s talk. Going into the second half of this year, I’m definitely going to try to focus more on my diabetes for today, and for the now.

Because in the grand scheme of things, the now is what is going to get me to where I want to be in the long run.

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After a few infusion site failures of late, I’m starting to become really self conscious. After every new site change, I become really paranoid of whether it’s a failure or success.

I poke my infusion site, trying blindly to detect a kinked piece of teflon that should be sitting underneath my skin. I prod around the infusion site on my stomach, trying to feel bruising and pain. I stand still while my pump is delivering an insulin bolus, waiting on edge to detect any stinging. I lift up my jumper compulsively, watching the colour of the skin underneath my site like a hawk.

I think about whether the skin tissue underneath my infusion site is strong enough to handle 3 days worth of insulin boluses. I frequently glance at my Total Daily Dose history on my pump, questioning whether it’s too high. I feel guilty for the carbohydrates I am consuming, for the sake of the subsequent insulin boluses that will have to go underneath my skin.

I check my levels like crazy after a site change, impatiently looking for signs that the insulin is heading successfully underneath my skin. I keep an eye on glucose movements like a hawk. In a moment of paranoia on Saturday, I even ripped out a perfectly good infusion site because the correction was taking too long to work it’s magic.

I draw dots on my stomach in permanent marker, in a desperate bid to keep on top of site rotations. I stare persistently at the real estate on my stomach, deliberating over just the right spot to place my new infusion site. I worry about how soon I will be able to re-use an area of real estate again.

In moments of site failures, I question whether this is really worth it. I think about results around my diabetes, and I’m almost certain that I won’t see any improvement yet. I’d be lying if I said I haven’t had fleeting thoughts that maybe this is not working for me. I worry that I won’t be able to make this work for me. I stand in my room for minutes on edge, pacing, deliberating over a site change or a shot of Lantus.

But when I think about going back to Lantus, I think about the level of control I will lose around my basal insulin rate. I think about how unfocussed I was on injections, blindly guessing and correcting all the time. I think about all of the time and investment I’ve put into this insulin pump, and I know that I’m not ready to pull away from it just yet.